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8. OUTLOOK FOR THE
FUTURE
8.1 Overall
assessment and strategic issues
Since independence more than 30 years ago, the Government
of Bangladesh has invested substantially in the institutionalization and
strengthening of health and family planning services, with special attention
to rural areas, and the government is committed to HFA with PHC as the key approach. For the last 30 years,
there has been a substantial improvement in the health status of the people.
Life expectancy at birth has increased to 64.9 (2002), CDR has declined to
5.9 (2003), and TFR reduced from
6.34 (1975) to 3.0 (2004) (Sample and Vital Registration System, and
Bangladesh Demographic and Health Survey 2004). The IMR
was around 53 (2002) (Bangladesh Demographic and Health Survey 2004). Despite
these improvements, much remains still to be done. Mortalities rates,
especially infant and maternal mortality, continue to be unacceptably high.
The quality of life of the general population is still very low. Low calorie
intake continues to result in malnutrition, particularly in women and
children. Diarrhoeal disease continues to be a
major killer. Communicable and poverty-related diseases that are preventable
still dominate the top ten causes of morbidity.
The government is aware of this situation and the major
shortcomings that need to be addressed, i.e., the development of an efficient
project management mechanism across the health system; improvement in the
logistics of drug supplies and equipment to health facilities at district and
lower levels; improvement in the production and quality of human resources
for health; a system to ensure regular maintenance and upkeep of existing
health facilities; and the development of a comprehensive plan to improve and
assure the quality of health services provided.
8.2 Futures vision
The government has formulated a perspective plan keeping
in view the needs of the health sector for the future. The formulation of a
national health policy would provide strategy directives on major health
issues. The future vision for the health sector would include universal
access to basic healthcare and services of acceptable quality; improvement in
medical education; improvement in nutritional status, particularly of mothers
and children; prevention and control of major communicable and
non-communicable diseases; strengthening planning and management
capabilities; improvement in logistics of production/procurement, supply and
distribution of essential drugs, vaccines and other diagnostics and
therapeutic equipment; increase in overall life expectancy of the population;
survival and healthy development of children; the health and well being of
women; protection and preservation of the environment; disability reduction;
and the adoption and maintenance of healthy lifestyles.
8.3 Proposed
strategies
The Health and
Population Sector Strategy (HPSS) introduced in 1998, which forms the basis
for the future national health policy, is based on several key principles:
greater orientation to client needs, especially those of women; improved
quality, efficiency and equity of government health services; provision of a
package of essential health services; expanded private sector role in
providing health and population services; one-stop shopping via co-location
of services; and expanded cost recovery and improved efficiency of resources
by the public sector.
Some of the main objectives are:
 To allocate more resources to support services
for poor, and vulnerable groups (women and children).
Unifying the existing bifurcated health and
family planning service delivery system.
To achieve an appropriate balance between the
public and private sectors in financing and provision of services.
Decentralization of management through
devolution of authority.
The following activities have been identified
to achieve the above objectives:
Deliver an Essential Services Package to the
whole population with the aim of maximizing health benefits, relative to per
capita expenditures. This is expected to meet the felt needs of the clients,
strengthen service delivery, and improve system management.
Service delivery mechanism should be unified,
restructured and decentralized, both at the thana
and hospitals.
Other services, particularly hospital-level,
are proposed to be provided through partnerships with or commissioning of
services to NGOs and private not-for-profit hospitals. The public sector
hospital services delivery will be improved through installing greater
autonomy of management, local level accountability, cost-recovery, fee
retention and utilization, and a drug revolving fund.
Integrated support systems should be
strengthened.
Introducing a sector wide approach to manage
the health sector, rather than having a series of projects with their own
funding, management, implementation and reporting arrangements.
In view of the potential resource gap between
the sectoral resource envelope and projected sectoral expenditures, increased reliance on cost
recovery for public sector services will be considered.
Health insurance coverage in urban Bangladesh
is proposed to be increased through development of a health insurance scheme
for government employees and for employees of state-owned enterprises.
At the centre, health will be more integrated
and decentralization taken to lower levels.
Hospital level services be focused and
improved.
Policy and regulatory framework be
strengthened. Existing policies will be reviewed and revised for improving
accessibility, affordability and quality of services and for further
improvements in affordability, quality and safety of drugs and rational use
of drugs. New policies on public and private sectoral
mix and financing of services will be developed
Related Links Ministry
of Health and family Welfare, Bangladesh
8.4 Basic Health
Indicators including the U.N. Millennium Development Goals MDGs
See Annex-1
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